|
|
Re: compromise of direct access campaign
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: compromise of direct access campaign - July 11, 2004 2:18:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
mcap
I agree with Diane - PTs having direct access to some patients seems a storm in a teacup when they at the same time see very unreasonable (clinically)things going on elsewhere in the health arena.
Is it professional jealousy (from others)or a desire/need to remain traditional technicians?
nari
|
|
|
|
|
Re: compromise of direct access campaign - July 12, 2004 5:00:00 PM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Dr. Wagner, I'm still interested in your opinions on direct access. I took the liberty to briefly speak with one of the MD's at our local hospital. He stated that there is no relicensing for the MD degree itself but a 10 year renewal for board certifications. This would parallel PT practice as I know it.
The continuing ed thing is still state by state but I think is actively being sought by all states. WI finally included it with its most recent revision of the practice act. Of course the APTA, as noted in another thread, officially endorses mandatory continuing ed.
The probationary year is an interesting idea and would be a reasonable public protection maneuver in my opinion.
I'm not sure where you were going with mandantory specialization.
At one point you made the following statement in response to my question about comparing direct access to the practice of medicine: "Since direct access for PT's is based upon state to state laws, I would need to see the written word to comment". I copied our "direct access" clauses out of the WI practice act if you care to comment on them.
(1) Written referral. Except as provided in this subsection and s. 448.52, a person may practice physical therapy only upon the written referral of a physician, chiropractor, dentist or podiatrist. Written referral is not required if a physical therapist provides services in schools to children with disabilities, as defined in s. 115.76 (5), pursuant to rules promulgated by the department of public instruction; provides services as part of a home health care agency; provides services to a patient in a nursing home pursuant to the patient's plan of care; provides services related to athletic activities, conditioning or injury prevention; or provides services to an individual for a previously diagnosed medical condition after informing the individual's physician, chiropractor, dentist or podiatrist who made the diagnosis. The affiliated credentialing board may promulgate rules establishing additional services that are excepted from the written referral requirements of this subsection.
1) In addition to the services excepted from written referral under s. 448.56, Stats., a written referral is not required to provide the following services, related to the work, home, leisure, recreational and educational environments:
a) Conditioning
b) Injury prevention and application of biomechanics.
c) Treatment of musculoskeletal injuries with the exception of acute fractures or soft tissue avulsions
(2) A physical therapist providing physical therapy services pursuant to a referral under s. 448.56 (1), Stats., shall communicate with the referring physician, chiropractor, dentist or podiatrist as necessary to ensure continuity of care.
(3) A physical therapist providing physical therapy services to a patient shall refer the patient to a physician, chiropractor, dentist, podiatrist or other health care practitioner under s. 448.56 (1m), Stats., to receive required health care services which are beyond the scope of practice of physical therapy.
Thank you,
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: compromise of direct access campaign - July 12, 2004 7:13:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
jon
Thanks for posting that information..
I was amazed to see how restricted and curtailed PTs are by law - this helps a lot with understanding the problems that I see aired frequently on this forum.
Nari
|
|
|
|
|
Re: compromise of direct access campaign - July 14, 2004 4:20:00 AM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
Newman!
(just had to say it)
90% of those who practice are board certified, if not higher, each and every specialist, each and every surgeon, each and every pediatrician and so on.
Those that are NOT board certified = those in training or not yet eligible, or those that have failed certification or those grandfathered in PRIOR to certification or you are in the military (flight surgeons did not do a residency and are not board certified).
ie no sense in doing residency if you aren't gonna take the boards...and when was the last time you met a physician (that is not 60) that did not do a residency?
Example, in Emergency Medicine you may not be hired or be credentialed by a group or hospital if not board certified in SOME specialty (EM, FP,IM).
After reading the Wisconsin law...so direct access in that state refers to schools, nursing homes, and conditioning? I like those aspects.
The direct access laws that I like are not the "off the street" type of laws, but rather the prescription renewal laws. A defined or known injury, a previous physician evaluation and then if the diagnosis has not changed, continued PT treatment...with re-evaluation by physician in 6mos.
That type of law protects the PT (initial Doc eval) and then continues uninterrupted PT treatment unless the diagnosis changes.
As for mandatory PT certification, this is an attempt at quality control.
example: PT 1 has practices in a nursing home in a direct (off the street) state, this therapist now fills in at an ortho clinic with the same large company in the same state. Who protects the patient (besides clinic ethics) from PT 1? If PT 1 has geriatric certification, but not orthopedic certification...then the patient should either be made aware, or the patient should not see the PT.
Mandatory certification would also (theoretically) allow for greater referral base (PR) and greater financial benefit AND add credibility to clinics. Flexibility in certification could allow for multiple certification (orthopedics, geriatric, neuro, peds, wound, generalist).
It would be mandatory for RE-CERTIFICATION and CEU's over time to maintain certification.
Minus residency, this is based upon the physician model.
I think it is quite good.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: compromise of direct access campaign - July 14, 2004 7:31:00 PM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Dr. Wagner,
I was waiting for someone to write it. I'm suprised it took this long!
Posting selected parts of the administrative code is bit confusing. In fact, I find administrative code confusing even if I posted it in full. Since very few insurances reimburse for direct access therapy (thus few or no people pursuing it in my neck of the woods), my full understanding doesn't seem absolutely essential at this point.
I don't know how to interpret the venue of therapy in the code. It starts with including certain venues, but then later just states a PT can see people with a previously diagnosed condition but without referral--no venue mentioned.
Now that I started the discussion, I'm discovering I don't get our own code. Funny enough the same type of thing happened to me a few years after being out of PT school in regard to treating pain. But I'm digressing.
Perhaps someone more legal savy, or more politically active than I, can help out(with the administrative code part).
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: compromise of direct access campaign - July 15, 2004 6:13:00 AM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
What do you think about my proposal for PT certification, reread if you need to.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: compromise of direct access campaign - July 15, 2004 3:49:00 PM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Dr. Wagner,
Currently the APTA requires mandantory re-cert every 10 years to maintain board certification in their designated specialties. A PT can have multiple specialties. I don't recall what their requirement (if any) for CEU is at this time.
I think the mandantory certification is an interesting proposal. I struggled quite a bit when I shifted from treating the over 65 crowd to outpatient ortho. However, requiring certification to see a certain type of patient may get confusing at some level. For example, if I were a generalist, could I work in any venue? If I saw someone who was over 65 for a shoulder problem, do I need geriatric certification or orthopedic?
I think that since we are all treating neuromusculoskeletal problems (theoretically) maybe requiring a specialization would be overkill. I have to let that idea roll around my head for a while.
Anyone else have comments?
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: compromise of direct access campaign - July 15, 2004 4:09:00 PM
|
|
|
FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
Status: offline
|
I feel that people should specialize IF they are going to be rooted in one spot. If someone is doing home care, or in a broad based hospital system and is the jack of all trades doing wound care one hour and then aqua the next, then I do not think they need to or SHOULD specialize. But if you are looking to be an orthopedic specialist like many on here seem to be, then why not show your committment to that one field by specializing. I do think the test is a bit pricey, but it IS good for 10 years. I am looking to finish up my manual certification, and would get a spine cert. if there was such a thing, because that is what I treat the most and am interested in the most, manual, spine, orthopedics. I primarilly got my OCS because I do private treat, clients more than patients, non medical referrals...if I were to be ever taken to court, which i should hope never happens, I feel that by showing that I rec'd the highest professional degree so there should be no question of "are you qualified to be doing that". Anyway, gotta run-
Ben Galin, MPT, OCS
|
|
|
|
|
Re: compromise of direct access campaign - July 15, 2004 6:58:00 PM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
This is the AMA policy on direct access to physical therapy according to their web site:
H-35.982 Direct Access to Physical Therapy.
Our AMA (1) affirms that the ordering of medical services for patients constitutes the practice of medicine and that legislation to authorize non-physicians to prescribe physical therapy and other medical care services should be opposed; and (2) encourages physicians who prescribe physical therapy to closely monitor their prescriptions to ensure that treatment is appropriate. (Res. 203, A-89; Reaffirmed: Sunset Report, A-00)
Any thoughts?
I should add that I'm not posting this to get a bee in PT's bonnets. In fact most PT's probably know about this policy. I posed a question earlier to Dr. Wagner inquiring if he felt direct access is tantamount to practicing medicine. The AMA does, but I'm not so sure. But then again, who cares what I think. What's important is to figure out why "they" feel that way and change their minds by offering rational thought (and considering their rational thought) or to just forget what they think and charge on. Of course, this is largely moot since most states have direct access laws already, but it would be nice if we could play together.
jon
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: compromise of direct access campaign - July 15, 2004 7:00:00 PM
|
|
|
Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
Status: offline
|
About certification for specialization, be sure to keep them embellishments to, rather than restrictions on a basic generic direct access PT practice.
A certification should be an enhancement, and not a limitation. An orthopaedic PT should still be able to practice in evolving (possibly even more "neuro") ways as new info becomes available. One should be able to get "certified" in more than one area if one wants. Certifications should be a mark of personal achievement, and create more prestige in a professional sense, but they should not reduce employment opportunity or self-employment in any legal way.
|
|
|
|
|
Re: compromise of direct access campaign - July 16, 2004 4:21:00 AM
|
|
|
Bill Egan
Posts: 52
Joined: April 22, 2001
From: Newton, MA
Status: offline
|
Jon or anyone else does the AMA represent the majority of MD's? From what I understand many, especially younger MD's, are not part of this organization.
Bill
|
|
|
|
|
Re: compromise of direct access campaign - July 16, 2004 7:38:00 PM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Bill,
I have no idea what the demographics of AMA membership is. I imagine they feel, like the APTA, there are not enough members.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: compromise of direct access campaign - July 17, 2004 1:33:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
The more I read about the system in the USA, the more strongly I feel that the drive should be towards autonomy. I cannot imagine life as a PT not able to treat without a medical diagnosis and then having to have another referral if that changes!
We are fortunate to be in the position of making our own diagnoses relevant to the problem/s.
The patient brings XRs and CTscans to the first session, and if there are none, and we suspect there are possible red flags from the history, we can request them from the patient's GP.
Referrals from doctors are treated as a courtesy letter only, Just as we would do to any health professional we were sending a patient to.
Isn't that worth something to fight for? I know the insurance companies may not be pleased; but, as they did here, they accept it eventually.
Just a thought...
Nari
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.094
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Re: compromise of direct access campaign 
